Cushing's Disease & the Menstrual Cycle

Also known as Cushing's syndrome, Cushing's disease is caused by a prolonged overexposure of the tissues of the body to the hormone cortisol. It is characterized by upper-body obesity, fragile, easily bruised skin, and in women, excess hair growth. Women with Cushing's disease can also experience irregular or disrupted menstrual cycles.

Causes

• Normally, your adrenal glands produce the hormone cortisol to help you stay alert and responsive to your environment. Cortisol helps to release fat and protein into your blood stream and maintain blood glucose levels so you have energy when you need it, but excess amounts can suppress the immune system and create oxidative stress. In Cushing's disease, irregularities or tumors in the pituitary gland cause the adrenals to release too much cortisol. Cushing's can also result from adrenal or other tumors, or long-term use of steroids for asthma, arthritis or other forms of inflammation.

Effects

• The elevated cortisol levels that cause Cushing's disease also cause menstrual irregularities, according to a 1998 study published in the Journal of Clinical Endocrinology & Metabolism. Excess cortisol prevents the hypothalamus in the brain from releasing an important chemical called gonadotropin. Without gonadotropin, levels of estrogen and progesterone--hormones essential to maintaining a regular menstrual cycle--drop.

Solutions

• The most common treatment for Cushing's disease is surgery to remove the tumor from the pituitary gland. According to Dr. William Ludlam of the Swedish Neuroscience Institute, surgery is 80 to 90 percent successful in treating Cushing's disease. If the surgery is not successful, radiation or medication are other courses of action that can correct the hormonal imbalance behind Cushing's disease.

Impact

• A primary concern for Cushing's sufferers with irregular menstrual periods is the impact on their fertility. There is also a strong relationship between irregular menstruation and osteoporosis, so women with Cushing's have additional cause for concern. According to the Cushing's Support & Research Foundation, after you have undergone treatment for Cushing's, your menstrual cycle should resume. If it has not returned to normal three to four months following treatment, consult your doctor to see if you need hormone replacement therapy.

Considerations

• If you have Cushing's, you may need treatment before becoming pregnant.

  It is rare to become pregnant if you have Cushing's disease, but it is possible. If you're uncertain whether you have Cushing's, becoming pregnant might make it more difficult for your doctors to diagnose you, since some symptoms of pregnancy overlap with symptoms of Cushing's. According to a 2005 study published in the Journal of Clinical Endocrinology & Metabolism, surgery to remove pituitary tumors can help manage Cushing's in pregnant women, but it is risky for your baby.